"What lies beneath it all?"--an interview study of GPs' attitudes to the use of guidelines.
BACKGROUND
General practitioners (GPs) adopt clinical practice guidelines to varying degrees. Several factors have been found to influence application of guidelines in practice and the GP is apparently the key actor. Studies are needed to increase our understanding of how GPs' attitudes influence their use of guidelines. In this study we explored GPs' attitudes to guidelines.


METHODS
In 2007 we conducted six semi-structured group interviews with a purposive sample of 27 Norwegian GPs. The participants were encouraged to discuss guidelines they were familiar with, the evidence base of guidelines, professional autonomy and doctor-patient relations. We used thematic content analysis to extract central themes and arguments.


RESULTS
When deciding whether tfollow guideline recommendations, GPs consider whether guidelines are trustworthy, whether they suit patients and whether the recommended action is feasible. There were two important findings. First, the GP's were concerned that guidelines may be more heavily influenced by economic considerations than clinical ones. Second, in contrast to earlier findings, changes in recommendations and disagreement between experts were mostly viewed positively.


CONCLUSIONS
This study underscores the need for transparency in the process of development and implementation of guidelines. To enhance the use of guidelines, primary care physicians should be involved in the process of developing guidelines and the process should be transparent and explicit regarding the evidence base and economic considerations.
Carlsen
Benedicte
B
Stein Rokkan Centre for Social Studies, The University of Bergen, Bergen, Norway. benedicte.carlsen@rokkan.uib.no
Norheim
Ole F
OF
D001291:Attitude of Health Personnel; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D005194:Family Practice / Q000592:standards*; D005260:Female; D006126:Group Processes; D015276:Health Care Rationing; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009664:Norway; D010358:Patient Participation; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology*; D017410:Practice Guidelines as Topic / Q000592:standards*; D017009:Professional Autonomy; D036301:Qualitative Research; D035502:Trust